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Young Woman With Syncope
IMAGES IN EMERGENCY MEDICINE Ryan P. Sullivan, MD; William E. Baker, MD; Mark W. Byrne, MD 0196-0644/$-see front matter Copyright © 2016 by the American College of Emergency Physicians. http://dx.doi.org/10.1016/j.annemergmed.2015.07.515
Figure 1. Bowing of the anterior mitral valve leaflet (arrow), thickening of the leaflet tips, and left atrial enlargement (arrowheads) on parasternal long-axis view.
Figure 2. Bowing of the anterior mitral valve leaflet (arrow) and thickening of the leaflet tips on an enlarged parasternal longaxis view.
[Ann Emerg Med. 2016;67:557.] A 37-year-old woman from Haiti presented to the emergency department after a syncopal episode. The patient experienced a stressful event, after which she developed palpitations and shortness of breath followed by loss of consciousness. On examination, a grade 2 of 6 diastolic murmur was auscultated. ECG showed normal sinus rhythm, and chest radiograph was interpreted as mild cardiomegaly. Echocardiographic images and videos were obtained with bedside ultrasonography (Figures 1 and 2; Videos E1 and E2, available online at http://www.annemergmed.com).
For the diagnosis and teaching points, see page 562. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com Volume 67, no. 4 : April 2016
Annals of Emergency Medicine 557
Correspondence
Anthony S. Kim, MD, MAS Department of Neurology University of California at San Francisco San Francisco, CA For the KP CREST Network Investigators http://dx.doi.org/10.1016/j.annemergmed.2016.01.036
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial,
562 Annals of Emergency Medicine
and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. 1. Ballard DW, Kim AS, Huang J, et al. Implementation of computerized physician order entry is associated with increased thrombolytic administration for emergency department patients with acute ischemic stroke. Ann Emerg Med. 2015;66:601-610. 2. Bender R, Lange S. Adjusting for multiple testing—when and how? J Clin Epidemiol. 2001;54:343-349.
Volume 67, no. 4 : April 2016
Figure 1. Bowing of the anterior mitral valve leaflet (arrow), thickening of the leaflet tips, and left atrial enlargement (arrowheads) on parasternal long-axis view.
Figure 2. Bowing of the anterior mitral valve leaflet (arrow) and thickening of the leaflet tips on an enlarged parasternal longaxis view.
[Ann Emerg Med. 2016;67:557.] A 37-year-old woman from Haiti presented to the emergency department after a syncopal episode. The patient experienced a stressful event, after which she developed palpitations and shortness of breath followed by loss of consciousness. On examination, a grade 2 of 6 diastolic murmur was auscultated. ECG showed normal sinus rhythm, and chest radiograph was interpreted as mild cardiomegaly. Echocardiographic images and videos were obtained with bedside ultrasonography (Figures 1 and 2; Videos E1 and E2, available online at http://www.annemergmed.com).
For the diagnosis and teaching points, see page 562. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com Volume 67, no. 4 : April 2016
Annals of Emergency Medicine 557
Correspondence
Anthony S. Kim, MD, MAS Department of Neurology University of California at San Francisco San Francisco, CA For the KP CREST Network Investigators http://dx.doi.org/10.1016/j.annemergmed.2016.01.036
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial,
562 Annals of Emergency Medicine
and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. 1. Ballard DW, Kim AS, Huang J, et al. Implementation of computerized physician order entry is associated with increased thrombolytic administration for emergency department patients with acute ischemic stroke. Ann Emerg Med. 2015;66:601-610. 2. Bender R, Lange S. Adjusting for multiple testing—when and how? J Clin Epidemiol. 2001;54:343-349.
Volume 67, no. 4 : April 2016